Prolonged Intercostal Block With The Use Of Subpleural On-q Catheters
Farid Gharagozloo, MD, Ramachandra Reddy, MD, Daniel Beckles, MD, Prashant Shah, MD, Ugo Ogwudu, MD, Giuseppe Tavilla, MD, Amber Malhotra, MD.
Baylor Scott and White Medical Center, Temple, TX, USA.
BACKGROUND:Postoperative pain relief is paramount for decreasing complications following robotic thoracic surgery. Intercostal blocks with liposomal bupivicaine has been advocated as a means of providing pain relief. However the effect of intercostal blocks lasts for up to 96 hours. Direct prolonged intercostal pain relief with continuous infusion of local anesthetic through subpleurally placed catheters for ten days postoperatively represents an attractive alternative with longer pain relief.
METHODS: We have devised a technique for the placement of two 5 inch on-Q Pain-Buster catheters in tandem in a subpleural tunnel encompassing intercostal spaces 3 through 8 under direct vision by the surgeon at the end of the robotic thoracic surgical procedure. The catheters are connected to the on-Q elastomeric reservoir with a regulator valve for infusion of 0.5% bupivacaine at 2ml/catheter/hr. The catheters are used for 10 days by using a second reservoir and the patients are discharged from the hospital with the catheters in place. We retrospectively compared postoperative pain relief in these patients (SP) to patients who underwent 6 level posterior intercostal nerve block with 2cc of 13.3mg/ml liposomal bupivacaine (C). Pain was assessed using a Likert Pain Scale. The use of narcotics was recorded and expressed as morphine equivalents. RESULTS: 82 patients were enrolled (41 in each group, C and SP) Patients were propensity matched. Age, Sex, performance status, and preoperative risk factors were similar between the two groups.
| Mean Likert Pain Score (0-10) | POD1 | POD4 | POD7 |
| C | 4.6 | 3.4 | 3.0 |
| SP | 3.8 | 2.9 | 1.4 |
| NS | NS | P<0.5 |
| Narcotic Use: Morphine Equivalent (mg) | POD1 | POD4 | POD7 |
| C | 45.8 | 33.4 | 32.2 |
| SP | 35.0 | 27.1 | 10.1 |
| NS | NS | P<0.5 |
CONCLUSIONS: Prolonged subpleural infusion of local anesthetic is a viable means of achieving longer term pain control with decreased use of narcotics in patient undergoing robotic thoracic surgery.
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